The objective of this grant is to bring together a collaborative research team including anthropologists, epidemiologists, health care personnel from the Choctaw Health Center (CHC), members of the Mississippi Band of Choctaw Tribal Council, and others necessary to forge a program to investigate factors contributing to the risk and complications of diabetes among the Mississippi Choctaw. The Mississippi Choctaw comprise approximately 6,000 Native Americans living in seven separate communities through out central Mississippi. A preliminary review of the charts at the Diabetes Unit at the CHC indicated 657 diagnosed case of diabetes. Nearly 50% of the diabetes are hypertensive, seven are on renal dialysis, and 11 patients had amputations during 1990. While this paints a dismal picture, the true extent of the problem is not yet known. Our approach is three-fold: 1) we will draw from an on-going preliminary study of health risk among the Mississippi Choctaw being conducted by one of the collaborators: 2) we will conduct a chart review at the Choctaw Health Center to estimate prevalence of diabetes and diabetic complications and to describe the distribution of diabetes across seven communities of Mississippi Choctaw; and 3) we will work with the collaborators from the Choctaw Health Center and the Mississippi Band of Choctaw to devise a follow-up research proposal that is responsive to the interests of these groups. The preliminary study will provide data on 150 adults from all seven communities consisting of anthropometric measurements, fasting plasma glucose (finger stick), blood pressure, previous diagnosis of diabetes, estimate of American Indian heritage language ability, occupation, income, education, household composition, consumer lifestyle, social support, and health related behaviors including activity, diet, alcohol consumption. While this study is not explicitly focused on diabetes, we can use the information gathered to direct our inquiries into diabetes risk. The chart review will include information on several thousands of patients and provide preliminary diabetes and complication prevalence estimates, although these may be biased particularly by the lack of representation from communities far removed from CHC. Strengths of the proposed research include the collaboration of the CHC and Tribal Council; the apparently high prevalence of diabetes and complications among the Mississippi Choctaw; the expertise of the research team in the epidemiology of diabetes, the measurement of obesity, diet, and activity, and the measurement of lifestyle and social support, and the existence of a collaborative relationship for the ongoing health risk assessment.